Medical Mystery Monday #151 – wringing of the hands

Public service announcement for Boston friends – Sweet cupcakes are to.die.for.

Hi everyone! Long time no talk. This past weekend was my twenty third birthday, and in between bites of cake I had a lot of laughs about the whirlwind this past year has been.

A year ago my white coat was brand new (and still clean), my bookshelf was empty, and in all honesty I thought my stethoscope was broken because I kept putting it in my ears backwards. It’s safe to say that a lot has changed in just twelve short months. For starters, I’ve learned how to correctly use my stethoscope and perform a physical exam – I even picked up on stridor for the first time in clinic this week. I survived gross anatomy; Netter, Moore and Bates now permanently occupy the very bottom of my bookshelf. And on top of that, I spent two months in Africa.

Just typing that sentence is still wild to me and the whole experience continues to feel surreal. This weekend was an awesome reminder of how lucky I am to wake up everyday and do something I love. It wouldn’t be possible without the unconditional support of my family and friends so THANK YOU.

Today’s mystery is inspired by a case I saw in clinic last week. Enjoy!

While on your pediatrics rotation, your resident sends you to perform a complete physical exam on an 18-month old girl who is brought to the clinic for her regularly scheduled check up. Looking back through the charts from her previous visits, you note that she seems to be in good health and meeting her developmental milestones.

You enter the exam room expecting an easy visit, but the girl’s mother brings up some serious concerns to you. Over the past few months the parents have noticed their baby is no longer picking up or holding objects like she used to. Instead she has started to “wring” her hands frequently. Additionally, the parents report that their child is no longer saying the words she used to know very well, like “mama” or “bye-bye”. She seems to be more withdrawn lately and takes less interest in the other children at the day-care center.

Before you are even able to begin the physical exam, the young girl breaks out into a screaming spell. Mom reports that these episodes are also increasing in frequency over the past few months. You do your best to perform the physical exam and find that the baby’s head circumference is falling towards the low end of the growth curve.